- Report Published -
|Annual Report to the Joint Commission on Health Care On the Impact and Effectiveness of the Pilot Programs to Expand Access to Obstetric, Prenatal, and Pediatric Services|
|Department of Health|
|§ 32.1-11.5 |
|The 2005 General Assembly passed HB2656 authorizing the State Board of Health to approve birthing center pilot projects as an alternative way to improve access to obstetrical and pediatric care in areas without inpatient maternity services. The passage of HB2656 permitted the pilot projects to employ certified nurse midwives (CNM) licensed by the Board of Medicine and Nursing to practice in collaboration with a physician rather than requiring a supervisory relationship with a physician. Pilot projects have been developed in Emporia/Greensville and in the Northern Neck.|
HB2656 required the Virginia Department of Health (VDH) to make an annual report to the Joint Commission on Health Care on the impact and effectiveness of the pilot programs to expand access to obstetrical and pediatric services in these communities. VDH has issued two such reports in 2006 and 2007 to the Joint Commission on Health Care on the progress made to date on the development of birthing centers.
In FY08, new Memoranda of Agreements (MOA) were established with Southern Dominion Health Systems, Inc. (SDHS) for the Emporia/Greensville project and with Rappahannock Rural Health Development Center (RRHDC), formerly known as Rappahannock Area Health Education Center (RAHEC) for the Northern Neck project. The MOAs contain provisions to administer start-up funds and provide management oversight for the two projects. Over the past 12 months, stakeholders in both communities have continued to perform work in support of establishing birthing centers utilizing the services of CNMs in accordance with the Board of Health’s recommendations.
Recognizing that a community’s commitment to this effort is essential to each center’s ability to become fully operational by the end of 2008, stakeholders and project staff have been very active in informing the public about the birthing center concept and garnering community support. Each project coordinator has worked collaboratively with VDH to assure that the required work plan deliverables have been accomplished within the given time frames.
SDHS (a federally qualified health center) has received approval from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) to expand its scope of service to provide women’s health and obstetrical services. The women’s health and birthing center facility will be located in Emporia in a newly leased facility.
On the Northern Neck the option to partner with a federally qualified community health center was not feasible, necessitating this group take a different approach. The stakeholders developed the Family Medical Center of Northern Neck (FMCNN) as a corporation and received approval from the Internal Revenue Services to operate as a 501 (c) (3). FMCNN is constructing a new facility and seeking certification as a rural health clinic (RHC).
The two projects are paying closer attention to the provisions in HB2656 for increased collaboration, which is critical to ensuring success. HB2656 specifically stipulates that there must be mutually agreed upon practice protocols and that the perinatal center agrees to provide administrative oversight and clinical consultation when requested. Both projects are collaborating with Virginia Commonwealth University (VCU), Obstetrics and Gynecology Department to develop the policies, procedures, and protocols that will govern the care provided in the proposed birthing centers.
The Department of Medical Assistance Services (DMAS) is working with the proposed birthing centers to examine reimbursement mechanisms under Medicaid. It is anticipated that based on the projected payer mix for these two centers, there will be heavy reliance on Medicaid reimbursement. Promulgation of any regulatory changes to the existing reimbursement structure will take approximately 18 months given the requirements of the Virginia Administrative Process Act. Changes to Medicaid reimbursement will affect the financial viability of these two projects.
As part of the Governor’s budget proposal to address the Commonwealth’s revenue shortfall over the 2008-2010 biennium, state funding for both the Emporia/Greensville and Northern Neck projects was reduced by $22,500 in FY2009, and proposed for elimination in FY2010. State funding for these projects was never intended or considered to be permanent. Rather, the funds were intended to be used to support the start-up of a pilot program, to coordinate the efforts of various local stakeholders and constituencies to develop the program. At this point, development of the initiative is essentially complete.
VDH continues to serve as a primary contact for the purposes of identifying and collaborating on the implementation of project tasks and priorities and will provide technical assistance for the purpose of expediting the project. VDH will continue to monitor the progress of the pilot projects and report on the impact and effectiveness of the pilot projects in meeting the program goals.